Acute lymphoblastic leukemia (ALL) and acute myeloid leukemia (AML) represent the most common forms of malignant diseases diagnosed in childhood. Unfortunately, these diseases are also among the leading causes of death in children, despite significant advances in treatment in recent decades. Improving survival prospects for children with leukemia largely depends on the speed of diagnosis and the timely initiation of complex hospital treatment. Especially with acute lymphoblastic leukemia, the success of therapy also depends on long-term outpatient follow-up and regular intake of oral therapy over several years, which poses additional challenges for families.

Access to healthcare as a key challenge

One of the key problems affecting treatment outcomes is the unequal availability of quality healthcare. Families living in certain types of neighborhoods, as well as those in smaller towns with less favorable socioeconomic conditions, face significantly greater obstacles in accessing necessary care. New research, such as that conducted at the University of California, San Francisco (UCSF), sheds light on specific neighborhood characteristics that can significantly increase the risk of death in children with acute lymphoblastic leukemia.

The study, whose results were published in the scientific journal Cancer, identifies new risk factors associated with place of residence. The authors emphasize that these neighborhood characteristics represent areas where clinicians and health policymakers can take targeted action to improve survival rates and save the lives of the youngest patients. Understanding these connections is crucial for developing effective support strategies.

Differences in risk depending on the type of leukemia and neighborhood

The research revealed worrying data: children diagnosed with ALL living in mixed-income neighborhoods (a combination of middle and low incomes), as well as those living in smaller towns with a predominantly Hispanic population (a specific finding of the American study indicating socioeconomic and potentially cultural barriers in certain communities), have between a 30% and 40% higher risk of death compared to children living in neighborhoods of higher-middle socioeconomic status. This significant difference points to deep inequalities that extend beyond medical care within hospital walls.

Interestingly, the same study found no statistically significant increase in the risk of death by neighborhood type for children with acute myeloid leukemia (AML). Researchers speculate that the reason lies in the nature of AML treatment. Specifically, AML treatment usually involves shorter but more intensive hospital cycles of chemotherapy and requires fewer outpatient visits compared to the long-term, multi-year outpatient treatment and maintenance required for ALL. The shorter duration of therapy and less reliance on the continuity of outpatient care likely reduce the impact of challenges faced by patients and families in socioeconomically deprived neighborhoods, such as transportation problems, medication availability, or parental absences from work.

Defining unfavorable neighborhood characteristics

What makes this study particularly important is its use of a new, detailed classification of neighborhoods based on as many as 39 different characteristics. These characteristics cover a wide range of factors, including:

• Availability and quality of food (e.g., whether unhealthy food stores predominate or there is a lack of access to fresh fruits and vegetables).


• Accessibility of pharmacies and the ability to obtain necessary medications without major difficulties.


• Availability and quality of public transportation, which is crucial for families without a personal car who must regularly travel for therapies and check-ups.


• Neighborhood safety, which can affect parents' willingness to take children on foot or by public transport.


• Concentration of poverty and unemployment.


• Housing instability and quality of housing.


• Access to green spaces and recreational facilities.

By analyzing these characteristics, the research team was able to more accurately identify the types of neighborhoods that pose a greater risk for children with ALL. This detailed analysis allows for the development of targeted interventions aimed at specific problems within the community.

The broader context of socioeconomic inequalities in pediatric oncology

The findings of this study fit into the broader picture of socioeconomic inequalities that significantly affect cancer treatment outcomes in children. Place of residence is not the only risk factor. Other important socioeconomic factors include:

• Family income: Lower incomes often mean greater stress, inability to cover transportation costs, medications not covered by insurance, or the inability of one parent to stop working to care for a sick child.


• Parental education: Higher levels of education may be associated with a better understanding of the complex treatment process, better communication with medical staff, and a greater ability to navigate the healthcare system.


• Health insurance status: Although children in many systems have basic care insured, the type of insurance can affect access to specialized centers, certain medications, or supportive therapies.


• Distance from a specialized pediatric oncology center: Families living far from the hospital face enormous logistical and financial burdens of travel and accommodation.


• Racial and ethnic differences: Studies, particularly in the US, show that certain racial and ethnic minorities have poorer treatment outcomes, often linked to systemic inequalities and socioeconomic status.

Recognizing these factors is crucial for understanding why children from different backgrounds do not have equal chances of survival, even with the availability of modern therapeutic protocols.

The importance of continuous care in ALL

Particular emphasis was placed on the long-term nature of treating acute lymphoblastic leukemia. ALL therapy typically lasts two to three years and includes various phases: induction, consolidation, and then a long-term maintenance phase mostly conducted on an outpatient basis. The maintenance phase is crucial for preventing disease relapse and requires daily intake of oral chemotherapy and regular medical check-ups and laboratory tests. It is precisely this phase that makes children with ALL particularly vulnerable to neighborhood-related barriers.

Problems such as irregular public transport, inability to reach a pharmacy for medications, or lack of financial resources to cover co-payments or travel costs can lead to missed medication doses or delayed follow-up appointments. Any interruption or irregularity in maintenance therapy significantly increases the risk of disease relapse, which dramatically reduces the chances of cure. Therefore, ensuring continuous and uninterrupted access to medications and healthcare services throughout the entire multi-year treatment is crucial for the success of ALL therapy.

Possible solutions and targeted interventions

Based on the identified problems related to neighborhood characteristics, researchers propose a series of targeted interventions that could reduce mortality rates and improve treatment outcomes. These interventions should aim to alleviate the specific obstacles faced by families:

• Improving access to pharmacy services: This may include home delivery programs for medications, collaboration with local pharmacies to ensure availability of specific oncology drugs, or mobile pharmacy services.


• Ensuring reliable transportation: Organizing transport for patients to medical appointments and therapies, either through hospital services, volunteer organizations, or subsidizing transport costs.


• Patient navigator or social worker services: Professionals who help families navigate the healthcare system, resolve administrative hurdles, connect with financial assistance resources, and coordinate care.


• Community support: Developing support programs within the local community, including parent support groups, help with caring for other children in the family, or food assistance programs.


• Telemedicine: Using technology for remote consultations and monitoring can reduce the need for frequent travel, especially for routine check-ups, although it cannot replace all in-person visits.


• Addressing food insecurity: Connecting families with food banks or nutritional assistance programs to ensure the child's nutritional status is not compromised.

Implementing such interventions requires collaboration between healthcare institutions, local communities, social services, and policymakers.

Striving for equal chances for all children

The ultimate goal of all efforts in research and improving care for children with leukemia is to ensure that every child has an equal chance of survival and a quality life after treatment, regardless of their family's socioeconomic status or the zip code they live in. Understanding how factors like neighborhood characteristics affect access to care and treatment outcomes is the first step towards developing a fairer system.

By ensuring that every child can receive a timely diagnosis, start treatment in a specialized center, regularly receive prescribed medications, and attend all necessary check-ups, we can significantly improve survival rates. Investing in removing socioeconomic and geographical barriers is not just a matter of social justice, but also a key element in the fight against childhood leukemia and saving young lives. Systematic work is needed to reduce inequalities so that medical advances are truly accessible to everyone.

Source: University of California